Agrawal Heena, Chaudhary Sujata, Salhotra Rashmi
Department of Anesthesia, Late Bisahu Das Mahant Memorial Medical College, Korba, Jhagarha, IND.
Department of Anesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2023 Aug 2;15(8):e42857. doi: 10.7759/cureus.42857. eCollection 2023 Aug.
Nalbuphine and clonidine are used as adjuvants to intrathecal local anesthetics, but studies on their comparative efficacy have shown inconsistent results. This study aimed to compare nalbuphine, clonidine, or normal saline as adjuvants to intrathecal hyperbaric bupivacaine in orthopedic lower limb surgeries. Method: Sixty-three American Society of Anesthesiologists (ASA) I/II patients between 18 and 60 years old with lower limb fractures were randomized into three groups (n=21 each). Patients with contraindications to spinal block, bilateral lower limb fractures, or long-term opioid therapy were excluded. The subarachnoid block was given in L3-L4 interspace. Group N received 1 mg of nalbuphine, group Cl received 30 mcg of clonidine, and group C received 0.5 ml of normal saline with 15 mg (0.5%) of hyperbaric bupivacaine. Sensory and motor block characteristics, hemodynamic variables and side effects were noted, and the data were analyzed using Student's t-test, Mann-Whitney test, Chi-square test, and ANOVA followed by Tukey's test.
Patients receiving intrathecal nalbuphine (group N) and clonidine (group Cl) had a faster onset of the sensory and motor block than controls (group C) (p=0.000). The time to two-segment regression was more prolonged in group Cl when compared to group N (p=0.000). Duration of spinal analgesia was 216.75 ± 25.96 minutes, 292.86 ± 24.92 minutes, and 178.50 ± 16.06 minutes in groups N, Cl, and C, respectively (p=0.000). The 24-hour rescue analgesic requirement was maximum in group C and least in group Cl (p=0.000). The three groups were comparable to each other in terms of side effects.
Clonidine was found to be superior to nalbuphine as an intrathecal adjuvant with no significant side effects.
纳布啡和可乐定用作鞘内局部麻醉药的辅助剂，但关于它们比较疗效的研究结果并不一致。本研究旨在比较纳布啡、可乐定或生理盐水作为鞘内高压布比卡因辅助剂在骨科下肢手术中的效果。
63例年龄在18至60岁之间、患有下肢骨折的美国麻醉医师协会（ASA）I/II级患者被随机分为三组（每组n = 21）。排除有脊麻禁忌症、双侧下肢骨折或长期使用阿片类药物治疗的患者。在L3-L4间隙进行蛛网膜下腔阻滞。N组接受1毫克纳布啡，Cl组接受30微克可乐定，C组接受0.5毫升含15毫克（0.5%）高压布比卡因的生理盐水。记录感觉和运动阻滞特征、血流动力学变量及副作用，并使用学生t检验、曼-惠特尼检验、卡方检验和方差分析（ANOVA），随后进行Tukey检验对数据进行分析。
接受鞘内纳布啡（N组）和可乐定（Cl组）的患者感觉和运动阻滞起效比对照组（C组）更快（p = 0.000）。与N组相比，Cl组两段回归时间更长（p = 0.000）。N组、Cl组和C组的脊髓镇痛持续时间分别为216.75±25.96分钟、292.86±24.92分钟和178.50±16.06分钟（p = 0.000）。24小时补救性镇痛需求在C组最高，在Cl组最低（p = 0.000）。三组在副作用方面相互可比。
发现可乐定作为鞘内辅助剂优于纳布啡，且无明显副作用。
